4. Laryngoscope, 126:1529-1534, 2016.

No abstract

Background The prescribing pattern of epinephrine over time is an indicator of the secular trend of anaphylaxis. However, it is not well known in a population level in the United States. Objective To evaluate the trend of prescriptions for epinephrine auto-injectors in Olmsted County, MN residents. Methods Outpatient prescriptions for epinephrine were identified among residents of Olmsted County, Minnesota, between January 1, 2004 and December 31, 2010. We used the first prescription per patient per year, and the first prescription per patient during the study period to calculate incidence rates. Incidence rates per 100,000 person-years were calculated using patients prescribed epinephrine per year as the numerator and age- and sex-specific counts of the population of Olmsted County as the denominator. The relationships of age group, sex, and year of prescription with incidence rates were assessed by fitting Poisson regression models using the SAS procedure GENMOD. Results The overall incidence rate of epinephrine auto-injector prescriptions during the study period was 757 per 100,000 person-years (95% CI 740–774). The prescription rates per patient per year increased over time, with an annual rate of increase of 8% (p<0.001), but the rates per patient remained stable (p=0.077). For each year, incidence rates overall were higher in women compared to men (p<0.001). From ages 0–19, incidence rates were higher in boys compared to girls. At age 20 and above, incidence rates were higher in women compared to men. Conclusion The overall rate of epinephrine auto-injector prescriptions increased, but the rate of first time prescriptions was stable from 2005–2010. In childhood, boys were more likely to receive a prescription than girls, but this reversed in later ages.

ObjectiveTo assess the functional and psychological features of patients immediately after discharge from the intensive care unit. MethodsProspective cohort study. Questionnaires and scales assessing the degree of dependence and functional capacity (modified Barthel and Karnofsky scales) and psychological problems (Hospital Anxiety and Depression Scale), in addition to the Epworth Sleepiness Scale, were administered during interviews conducted over the first week after intensive care unit discharge, to all survivors who had been admitted to this service from August to November 2012 and had remained longer than 72 hours. ResultsThe degree of dependence as measured by the modified Barthel scale increased after intensive care unit discharge compared with the data before admission (57±30 versus 47±36; p<0.001) in all 79 participants. This impairment was homogeneous among all the categories in the modified Barthel scale (p<0.001) in the 64 participants who were independent or partially dependent (Karnofsky score ≥40) before admission. The impairment affected the categories of personal hygiene (p=0.01) and stair climbing (p=0.04) only in the 15 participants who were highly dependent (Karnofsky score <40) before admission. Assessment of the psychological changes identified mood disorders (anxiety and/or depression) in 31% of the sample, whereas sleep disorders occurred in 43.3%. ConclusionsPatients who remained in an intensive care unit for 72 hours or longer exhibited a reduced functional capacity and an increased degree of dependence during the first week after intensive care unit discharge. In addition, the incidence of depressive symptoms, anxiety, and sleep disorders was high among that population.

Study Objectives: Abscess infections frequently present to the emergency department (ED) and are an opportunity to determine the molecular factors that contribute to disease severity. The goal of this work was to determine the concentration of host immune mediators including IFN-g, IL-17, IL-1b, and TNF-a and apolipoprotein B (apoB) in complicated and simple infections caused by Staphylococcus aureus. We hypothesized that complicated infections would have deficiencies in local host immunity and enhanced bacterial virulence. To test this hypothesis we measured both host proteins and bacterial virulence gene expression in complicated and simple abscesses.Methods: We obtained abscess fluid from subjects presenting to the ED with simple and complicated infections as defined by current clinical guidelines. We then performed multiplex protein analysis on collected abscess fluids and patient serum samples. In addition, we examined S. aureus virulence gene expression by quantitative-PCR.Results: We found differences in cytokine profiles with complicated abscesses having altered IFN-g, IL-17, IL-1b, TNF-a, and IL-10 responses when compared to simple abscesses. We found that apoB, which disrupts bacterial quorum sensing, was lower in complicated infections. In addition to differences in the local inflammatory responses, several bacterial virulence genes were upregulated in complicated infections. These genes include bacterial toxins and bacterial stress response genes.Conclusion: Together these findings translate clinical findings of disease severity into molecular determinants of pathogenesis and reveal a potential mechanism by which future antimicrobials could enhance treatment. Specifically, these data identify local host defects in inflammation and control of bacterial communication. These defects are associated with increases in bacterial virulence gene expression and reveal a potential role for quorum sensing inhibitors as a way of augmenting defective host immunity.